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valganciclovir + mycophenolate is a combination therapeutic regimen evaluated in the PROTECT clinical trial, sponsored by the University of Bologna, for the prevention of cardiac allograft vasculopathy (CAV) and cytomegalovirus (CMV) infection in heart transplant recipients. Valganciclovir is an antiviral prodrug of ganciclovir that inhibits viral DNA polymerase, thereby preventing CMV replication. Mycophenolate (typically administered as mycophenolate mofetil) is an immunosuppressant that acts as a reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH), an enzyme essential for the de novo synthesis of guanosine nucleotides in T and B lymphocytes. This specific combination is studied to compare universal prophylaxis against pre-emptive therapy strategies to determine their impact on coronary intimal thickening and long-term graft survival.
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